Chiropractor John Rosa was a board member for the Maryland University of Integrative Health in the early 2000s when practitioners across the country started noticing an uptick in the prescribing of opioid painkillers. It started with OxyContin, he said, and moved onto Percocet, Opana, Vicodin — a slew of potent narcotics prescribed for even acute injuries.

“We were all in these rooms together thinking, ‘Why is this happening?’” Rosa said. “I would go into meetings and be like, ‘Guys, are you noticing this, too?’”

For a provider of chiropractic therapy — an alternative, or complementary form of treatment that advocates for healing without drugs — the new trend was particularly concerning. Rosa has been in the business for 25 years and pushes for non-medicated pain management through musculoskeletal manipulation, movement therapy, and common-sense lifestyle changes such as diet and exercise.

Rosa, a regional provider with 14 treatment centers in the D.C. area, recently opened a clinic at the Menocal Family Practice on Baughmans Lane in Frederick, where he treats patients free of charge. He likes to say that he predicted the opioid epidemic before the issue became a source of national attention. Since then, the nationwide crisis has become a personal crusade.

Opioid prescriptions have gone down by 70 percent at Menocal Family Practice since Rosa started treating patients for pain management, a statistic confirmed by Dr. Julio Menocal, the owner of the office.

The chiropractor has also taken his advocacy to the federal level. In 2017, he was asked to serve as a surrogate to the White House commission on the opioid crisis. In March, he participated in the White House opioid summit and presented on the importance of integrative care.

“There’s just zero degrees of separation,” Rosa said. “I have friends, family, co-workers who have all been affected. And there are so many discussions on recovery, but when are we going to have a conversation about stopping the addiction in the first place?”

For Rosa, and a slew of alternative medicine providers across the country, complementary therapies should play a critical role in preventing opioid dependence and treating patients with substance use disorder.

Several states have expanded Medicaid to cover treatment such as chiropractic therapy and acupuncture, another nontraditional modality that uses needles to stimulate different points on the body.

As concern over opioids continues to grow, alternative providers have campaigned for more involvement and collaboration with more traditional forms of treatment. Kallie Guimond, a lobbyist turned acupuncturist with a practice in Frederick, has become another vocal advocate.

Last November, she organized a Congressional briefing on the role of acupuncture with help from Rep. Tim Ryan (D-Ohio) and Rep. Judy Chu (D-California), co-sponsors of a bill to expand acupuncture services to veterans.

The American Society of Acupuncturists (ASA) — on which she sits as a board member — helped write a white paper titled “Acupuncture’s Role in Solving the Opioid Epidemic.” Guimond also serves as a consultant for the Integrative Health Policy Consortium, which also held a briefing in March to announce the formation of an Integrative Health and Wellness Congressional Caucus and tout complementary solutions to the opioid crisis.

Like Rosa, Guimond has experience treating patients with opioid dependence and using alternative therapies to treat pain. She began her clinical training at the Penn North Community Resource Center in Baltimore, using acupuncture to treat substance abuse patients.

She started acupuncture treatment herself during a painful battle with cervical cancer and continued as she recovered from a hysterectomy and two surgeries to remove seven major tumors.

“From the minute I had my first acupuncture treatment, it was magic,” Guimond said. “I felt like I was superhuman in that moment — like I knew what it felt like to be firing on all cylinders. Acupuncture was the one thing I could put my hands on that really made me feel better.”

One of her patients, Terri Winn, feels just as strongly about the treatment. The 59-year-old Frederick woman began acupuncture with Guimond after the death of her son in September 2016 from a fentanyl overdose.

For Winn, acupuncture is more than just an effective treatment for the pain — manifested by grief, she said — that settled into her back and shoulders after her son’s death. She also believes that the therapy, and other alternative treatments, could have saved his life as he worked through the recovery process.

Her son was prescribed Suboxone — a synthetic opioid used to treat addiction — after being hospitalized for a hole in his esophagus, caused by violent vomiting as he was withdrawing from heroin, Winn said. But as he worked through recovery, her son often had trouble filling his prescription due to tighter regulations on opioids — an experience that made him feel alienated and stigmatized.

“I truly believe that if alternative therapies were an option for him, he might be alive today,” Winn said. “Can you imagine someone like my son — someone who’s 23 — going through that alone? We’re talking about kids, whose brains aren’t even fully developed, getting addicted to dangerous narcotics. They need to be looked at as a whole person.”

The problem for practitioners like Rosa and Guimond is that alternative therapies often remain inaccessible to the substance abuse patients who need them most.

While Maryland Medicaid covers both chiropractic and acupuncture for children under the age of 21 under the Early and Periodic Screening, Diagnosis and Treatment program, adults are not eligible for the service, according to Brittany Fowler, a spokeswoman for the Maryland Department of Health.

That totally excludes the majority of patients with addiction, who generally find themselves on medical assistance, Rosa said.

Alternative therapies are often controversial or overlooked among the medical establishment, he added. While chiropractic has been subjected to more rigorous research, clinical studies on the efficacy of acupuncture remain mixed.

Few doctors are willing to recommend either therapy over medication-assisted treatment — the current gold standard for substance abuse — and most don’t know enough about alternative medicine to make referrals.

“It’s frustrating because, in my mind, we’ve gone down the path of treating symptoms and moved away from healing the whole person,” Rosa said. Both he and Guimond would like to see their services covered by Medicaid, as well as private insurance, and for them to be seen as a first-line defense for both pain management and substance abuse recovery.

“When I see a patient, I almost don’t care about the specific pain they’re feeling,” Rosa continued. “I want to know the root cause — be it diet, obesity, or lifestyle changes they could make to help alleviate what they’re feeling. We’re the ones equipped to take a holistic approach — getting to the cause of the symptom rather than treating the symptom itself.”

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(4) comments

I am afraid that the most uninformed people regarding the crisis are the ones who use Opioid medications the most in practice like nurses and doctors. When these medications are used for there intended purpose (cancer patients, severe trauma and post surgical) they do make a positive impact. Here is where the insiders are missing the heart of the crisis.- 70-80% of heroin users trace back their use and addiction to a prescription Opioid- the medical profession changed the prescribing habits based on non-conclusive research stating opioids where non addictive- The Drug manufactures lobbied to make pain the 5th vital sign and opioids where givin to anyone with pain level of 3 or greater on a scale of 10.- The government gave bonuses to hospitals that controlled pain with smiley face surveys for pain- The VA in 1998 sent out notification to all health systems to control pain with opioids- Diversion tactics saw massive amounts of medication sent to pill mills hit the streets- over 90% of Opioid medications are consumed by the US and the US makes up 5% of the worlds populationSo let’s ALL wake up and realize that if you follow the money (drug companies, Doctor bonuses, campaign contributions and drug dealers with ivy school rings) You will see where a majority of the crisis comes from. Doctors and nurses are complicit in this epidemic. Some by greed and some by ignorance. We should never let the crisis not enable the people who truly need the medications not receive them but we should with greater conviction NEVER let the people who do not need it get it prescribed. Every governing body and accrediting agency that create guidelines for treating pain (CDC, VA, American College of Physicians and Joint Commission to name a few) have recommended or required that physicians use Integrative Medicine as first line of pain treatment in lieu of opioids. They specifically state the Integrative Modalities as Acupuncture, Chiropractic, physical therapy, yoga therapy, massage and mindfulness. If we would just listen to the recommendations and understand the proven evidence based treatments we could make a major impact on the crisis. This is not a cure all or the only ansewer to Prevention but people need to listen and stop the fear mongering that Integrative Medicine doesn’t work. My wish is that we never accept an opioid for mild to moderate trauma, chronic pain or minor surgical procedures without trying Integrative Medicine FIRST. You know why the other 95% of the worlds population doesn’t consume opioids like we do? Because they us the things that have worked for thousands of years before this self inflicted chemical warfare began. There is a reason that patient satisfaction surveys are dramatically higher for the practitioner types listed in this article when compared to medicine.

How are these patients getting "alternative treatment" outside of their home, if they are in intractable pain getting into a vehicle, not to mention every little bump in the road making them scream in pain? As a registered nurse (not an aide) stated to me about this opioid hysteria, "due to the bad behavior of a few, pain relief is being declined for patients who really need it." One thing that is not brought up is that patients with legitimate pain do not get euphoric with things like Vicodin and Percocet. In fact, patients experience nausea and sometimes vomiting with those (since the patient does not have food in their system to counteract (e.g., after surgery)), not getting "high." The grieving parents who have lost a child are the ones driving this hysteria and demanding politicians to "do something." I feel sorry for their pain. I also know the parents (in-laws family of two of my family members) who lost their only son to one of the major opioids. (I'm withholding identifying information, so that I don't moderated out by FNP). Needless to say and as reported in a lot of media, losing a child is devastating. The poor parents' lives will never be the same. But, the fact remains that the vast majority of patients use opioids only as long as they need them, which is typically only a few days (e.g., after surgery). For those with spinal cord injuries and other chronic medical issues, they need the pain relief. In addition, (as I've said in previous posts), I saw in my late mother's case, where hospice was not on the ball with any pain relief. It wasn't until I interceded that they gave her a small amount of morphine. I will never forget it as long as I live. When it was determined back in '80s that adequate pain was not being provided by a significant number of physicians to patients with terminal illness, especially--well, that has gone out the window now. I suspect that a lot of people (even more than is experienced currently with the restrictions) will be suffering. And, maybe these politicians and physicians who are promoting restrictions in necessary pain relief will realize on their deathbeds that they went too far "throwing the baby out with the bath water." Or maybe before that time, they personally see a loved one in agony, they'll think.

BTW, I came across an insurance website (I was looking for something else) and they were controlling the meds and not just for pain relief. They were using the new thinking that their goal is to "manage" pain, not relieve it as well as getting between doctors dealing with their patients. A lot of buzz words don't help, folks, and alternative practices do not help patients in regard to some medical conditions. In fact, they are contraindicated in some conditions.

Sue1955 You made some valid points. I had reservations about this article when I read it also. But it is a crisis. How did people handle pain 30 years ago? Managed pain relief is the key phrase. Maybe they should have a new category: Controlled Highly Dangerous Substance. I understand your concerns but it is far beyond the bad behavior of a few. Day after day we read of another young soul dying just in this area. That happens in every locality of the country. People are screaming about the NRA but they are saints compared to Big Pharma.

The NRA is the propaganda arm of the gun manufacturers and together they are as bad as pharmaceutical companies. Human lives are of no consequence to either of them, they are just collateral damage in their profit analysis.

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